Provider Demographics
NPI:1851407753
Name:SODEIFI, ALIREZA MICHAEL (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:MICHAEL
Last Name:SODEIFI
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18805 COX AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6614
Mailing Address - Country:US
Mailing Address - Phone:408-222-3354
Mailing Address - Fax:
Practice Address - Street 1:18805 COX AVE STE 130
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6614
Practice Address - Country:US
Practice Address - Phone:408-222-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557001223S0112X
CAA103172204E00000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU98378Medicare UPIN
MO915104675Medicare ID - Type Unspecified